Prior authorization is necessary to ensure benefit payment.
You may prescribe a health care service, treatment, equipment or medication to your patient which requires prior authorization. You may submit a prior authorization request through our online provider center or complete a prior authorization and referral form. For Applied Behavioral Analysis (ABA) therapy authorization requests, ABA providers should submit this form.
The goal is to ensure health plan members receive the most appropriate, medically necessary care. All requests are reviewed by a licensed physician or under the supervision of one. Furthermore, only a physician may deny a request.
You may file an appeal if coverage is denied. To appeal a decision, mail a written request within 180 days from the date of the denial to: Sierra Health and Life, P.O. Box 15645, Las Vegas, NV 89114-5645.